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January 2010    Download the Entire Issue (PDF) Available to the Public Vol. 36, No. 1   RSS Feed for Undercurrent Issues
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Lying About Your Health Could Be Lethal

our medical expert tells you why you shouldn’t fib to dive shops

from the January, 2010 issue of Undercurrent   Subscribe Now

Last month, we published reader comments about how much, if any, health information you disclose on the dive shop medical questionnaire. Most of you say you keep mum. I saw many of the reasons you gave for why as quite valid. Doc Vikingo, a frequent Undercurrent contributor, does not. Here’s his opinion:

Scuba diving, perceived by much of the non-diving public as risky if not outright dangerous, has avoided government meddling to an astonishing degree. Regulation by federal, state and local governments has been avoided largely because the dive industry polices itself. This includes common practices like asking divers to complete a medical history questionnaire before training or a taking a dive trip. This self-policing has benefited divers by giving them freedom to dive whenever, however and with whomever they choose. Much of this is obviously due to divers adhering to industry practices. But when it comes to being forthright in completing medical questionnaires, it’s sometimes a different story.

When Undercurrent asked readers about whether they disclose medical conditions to dive operators, a surprising number of you replied that you didn’t, for fear of an operator not permitting you to dive. But I’m with much of the dive industry and medical experts in believing it’s a mistake not to tell the truth about your health. It could cost you your life, and possibly the lives of the buddies and guides you’re diving with.

The risks are real. For example, Divers Alert Network’s annual report on dive-related accidents and deaths routinely indicates that cardiovascular events cause 20 to 30 percent of all fatalities. Moreover, medications like tranquilizers, antidepressants and narcotic pain relievers and certain cardiac and respiratory drugs that cause no problems topside may act differently at depth, and may combine with or increase nitrogen narcosis, resulting in significantly impaired thinking and behavioral control.

“The Diver’s Responsibility, not the Dive Center’s”

Consider this tale sent in by an Undercurrent reader about a Bahamas dive he did last June. One of his fellow divers was a 68-year-old woman who looked physically fit and at least a decade younger. However, during the first dive, one of the divemasters had approached her at 75 feet, motioning for her to ascend a bit but she kept descending. At 100 feet, the divemaster physically tried to force the woman to ascend but was pushed away. He partially inflated the woman’s BCD but she immediately dumped the air through her shoulder valve. Another divemaster then descended to 170 feet and could see the woman’s bubble line starting well below his depth. He used the backup tanks suspended below the boat to decompress from the extreme depth. The woman’s body was never found.

Our reader later learned through a mutual acquaintance that the woman had had a minor stroke the month before that Bahamas dive. “There has been considerable speculation about the cause of her actions and subsequent disappearance,” he wrote us. “While we may never know for certain, the leading theories are that she either got nitrogen narcosis at 70 feet, or suffered a stroke and became confused and disoriented. If she had a transient ischemic attack, or TIA, (a ‘warning stroke’ or ‘mini-stroke’ that produces stroke-like symptoms but no lasting damage.) the month prior, my medical friends indicate it is dubious she would have received a physician’s clearance to dive. There are generally other underlying medical issues, and a greatly increased risk of suffering another stroke after a ‘minor’ TIA stroke.”

Out of curiosity, our reader e-mailed PADI and asked about its fitness-to-dive policy. The reply: “While dive students are required to complete a medical history questionnaire before participating in any PADI courses, PADI diving facilities are not required to medically screen all of their customers. Divers learn during their training that, after certification, they must always ensure that they are medically fit for diving before doing so. This is the diver’s responsibility rather than the dive center’s.”

“If divers knowingly conceal their
conditions once they know what the
risks are, it’s not just themselves
they’re putting at risk . . .”

Because so many of you readers admit that you are untruthful on the medical release, we wondered if dive medicine experts did the same, just to avoid the hassle of dealing with dive operators who have far less medical knowledge. Ern Campbell, M.D., a.k.a. the blogger ScubaDoc, said that even if he had a condition he feared may prevent a dive operation from taking him on board, he still “would disclose the condition to the operator and expect an appropriate explanation of any denial to dive.” Dr. Michael Bennett, president of the South Pacific Underwater Medicine Society, told us: “I believe the medical risks of diving are real and present a threat to my well-being. Therefore, I would not be selfish enough to cheat and put my fellow divers at risk when they might be called upon to save me!”

Drugs Work Differently Underwater

Common reader statements we received included, “I’m capable of monitoring my own medical problems” and “I don’t pose a danger.” In many cases, such assertions are not accurate. For example, common conditions like asthma, diabetes and seizures may appear well-managed but can unexpectedly and rapidly spiral out of control. When they do so underwater, the results can be deadly. The altered environment in diving (e.g., water that’s cooler than body temperature, exertion, increased partial pressures of gases) can precipitate relapses. The fact is the potential effects of such changes upon most medical conditions -- and the drugs used to control them -- are not known with certainty.

Other readers responded along the lines of, “What does the dive op know about the implications of my medical issues for scuba?” The answer is, “Probably very little.” This is why the shop can quite reasonably ask you to report your medical status, and may require a signed clearance to dive from a physician who does understand the implications. Remember, if a dive crew is unaware of your medical disorders, appropriate treatment could be substantially delayed.

In a related vein, some readers believed that a dive operator asking for such personal information was in violation of their right to medical privacy. Actually, it isn’t. The privacy provisions of the Health Insurance Portability and Accountability Act (HIPAA) are binding on healthcare insurers, providers and facilities, not dive operators and training agencies. You voluntarily waive your “right” to keep your medical information private when you contract for dive certification or a two-tank dive. It is the operator’s perfect right to ask the diver to be honest regarding medical conditions that could mean additional risks to the business, other customers and the diver himself. There is nothing illegal, unethical or inappropriate about this. From a liability standpoint, dive businesses would be insane not to.

You’re not the Only Diver on the Boat

Perhaps the lamest of the excuses was, “It’s my life and my choice to dive with a disease.” This might be arguable if you are an unemployed solo diver without family or friends. However, if you are diving with a dive operator and other customers, then your fitness to dive most assuredly is of concern to them.

When you are less than honest in revealing your medical status, not only could you as the diver be harmed, but so could your buddy, divemaster or others who risk their lives to save yours. Karl Huggins, program director of the University of Southern California’s Catalina Hyperbaric Chamber, says that if individuals “... knowingly conceal these conditions once they know what the risks are, it’s not just themselves they’re putting at risk but also those who may need to respond to them in an emergency situation.” He goes on to say, “Divers may rationalize that ‘It’s my life and I can assume any risk I want because the damage I do, I do to myself.’ But when they’re paralyzed and can’t do their job or function normally in their work and personal lives, is it just themselves they’re affecting?”

Not to mention that you could cause a dive trip to be aborted for everyone, possibly on an expensive liveaboard in a far-flung location, because the crew needs to rush you to medical care. Under these conditions, liveaboards make no refunds to any divers on the itinerary. If you’re lucky enough not to expire from your previously undisclosed medical condition, you might be thrashed to death by the other passengers.

If and when enough divers lie, incidents will occur and they eventually will catch the government’s eye. When that happens, laws will be passed, like requirements of medical exams before receiving dive training and mandatory completion of a medical history form in Australia, Malta and other locations. A number of preventable diver deaths due to medical reasons have occurred in Australia’s Queensland region over the past several years. Many were the result of divers being untruthful about their medical status and made news headlines. This resulted in the government considering even more rules and tighter enforcement. Do you want some random diver’s failure to disclose medical conditions that led to a bad dive accident or major fatality to lead to tighter restrictions on your own dives?

You participate in recreational scuba on a voluntary basis. No one is forcing you to do it. It’s a recreational pastime, a fun thing to do. If you don’t like being asked to properly and truthfully complete a medical questionnaire, a practice intended to protect customers and the businesses that offer them scuba services, you don’t have to participate. You can find diversions with rules that better suit you and don’t require total disclosure of your medical history. Heaven knows there are dozens of them that don’t put you and others in such a potentially hazardous situation.

- - Doc Vikingo

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